Probiotics in diverticular disease: not ready for prime time?

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Author: Mario Guslandi
Date: Sept. 2013
Publisher: Expert Reviews Ltd.
Document Type: Report
Length: 1,445 words
Lexile Measure: 1570L

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Author(s): Mario Guslandi 1

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diverticulosis; divericulitis; enteric flora; mesalamine; probiotics

Overgrowth and alteration of the enteric flora are a cause of symptoms and inflammation in diverticular disease, hence the use of probiotics in the treatment and prevention of uncomplicated diverticulitis can be postulated.

At the present time, only a few controlled studies are available, suggesting that some, but not all, probiotic agents may effectively provide additional benefit when combined with either high-fiber diet or mesalamine.

The diverticular disease of the colon is a common condition in the Western world, especially in elderly people, with a prevalence of about 65% in subjects aged over 65 years [1,2] .

While the majority of patients with colonic diverticulosis remains asymptomatic, in up to 20% of cases recurrent episodes of abdominal pain with or without frank inflammation (diverticulitis) will develop [1,2] . One of the possible mechanisms of diverticular inflammation is represented by overgrowth or alteration of the enteric flora, which provides the rationale for the use of a non-absorbable antibacterial agent such as rifaximin [3,4] in addition to dietary fiber supplementation and/or mesalamine administration [4] . Reducing proliferation and maintaining the balance of the gut microbiota could also be beneficial in the treatment of symptomatic diverticular disease due to a decreased production of intestinal gas such as hydrogen and methane [4,5] .

Probiotics might be useful in treating and/or preventing uncomplicated diverticulitis, by inhibiting enteric pathogens, competing with pro-inflammatory microbes and stimulating local immunological defenses, thus reducing both local inflammation and excessive gas production.

Despite the enormous potential and the overall good safety of probiotic agents in this area, only a limited number of studies are currently available.

On the whole, pilot, open studies provided quite promising results.

Escherichia coli non-pathogen strain Nissle 1917 administered for 6 months to a small group of patients with uncomplicated diverticular disease was found to prolong the length of clinical remission and to improve abdominal symptoms compared with before treatment [6] .

Similarly, when in a prospective, open-label study, a mixture of Lactobacillus acidophilus 145, Lactobacillus helveticus ATC 15009 and Bifidobacterium spp. 420 was given for 6 months to 46 patients 68% remained symptom free at the end of the treatment [7] .

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Gale Document Number: GALE|A343898796